


Teachable Moments

by apolesen



Category: Star Trek: Deep Space Nine
Genre: Alien Cultural Differences, Background Garashir and Garak/Parmak, Background Poly, Background Relationships, Conversations, Fights, Friendship, Gen, Holodecks/Holosuites, Medicine, medical ethics
Language: English
Status: Completed
Published: 2019-04-29
Updated: 2019-04-29
Packaged: 2020-02-10 00:08:42
Rating: Teen And Up Audiences
Warnings: No Archive Warnings Apply
Chapters: 1
Words: 3,542
Publisher: archiveofourown.org
Story URL: https://archiveofourown.org/works/18648916
Author URL: https://archiveofourown.org/users/apolesen/pseuds/apolesen
Summary: Bashir wants more practice diagnosing Cardassian patients, but the medical training holo-programme that Parmak provides leads to culture shock and arguments about medical ethics.





	Teachable Moments

**Author's Note:**

> This fic is set in a version of events where Garak and Parmak return to DS9 for a while during the rebuilding effort on Cardassia.
> 
>  
> 
> Trigger warnings: discussion of abusive medical practices.

Julian Bashir entered Quark’s at a run. Not stopping to say hello to Morn, he ran across the bar and climbed the spiral staircase three steps at a time. From the level above, he heard a familiar voice. 

‘We don’t do refunds. You pay for any damage, with interest. And any reservation is forfeited if the holosuite isn’t used five minutes after the starting time.’ 

Bashir launched himself up the last steps. 

‘I’m here, I’m here,’ he gasped. ‘Sorry.’ He leaned down to catch his breath. When he straightened up, he could not help chuckle at the sight in front of him. Quark looked like he always did, short, bald and gaudily dressed. Doctor Parmak was his opposite in so many ways: he was tall even for a Cardassian, with thick white hair in a long braid and clothes in such muted colours it made Julian’s uniform feel flamboyant. 

‘You’re just in time, Doctor Bashir,’ Parmak said. 

‘With about forty seconds to spare,’ Quark added, unlocking the holosuite. He grinned at them both. ‘Enjoy yourselves, gentlemen.’ 

‘It’s not like that,’ Bashir shouted after him. He turned back to Parmak. ‘Sorry about him.’ 

Parmak chuckled. 

‘To be honest I find him rather refreshing.’ He gestured at the open doors. ‘Shall we?’ 

They stepped inside. No programme was running yet, leaving the walls and consoles visible. 

‘So what is it you’ve got planned?’ Bashir asked as Parmak made his way to the controls in the corner. ‘It’s not an enigma tale, is it?’ 

‘Not at all,’ Parmak said. ‘I would not do that to you, Doctor. No, we’re here for business, not pleasure.’ 

Bashir felt intrigued. 

‘What’s that supposed to mean?’ 

Parmak took a data-rod out of the case he had brought and slotted it into the console. The space around them changed. 

The room was roughly the size of the holosuite itself. The only thing decorating the off-white walls was a poster of an undressed Cardassian, standing stiffly with his head turned in profile. Instead of the bare chest and stomach, the poster showed the vital organs. In the middle of the room was an examination table. A number of trolleys stood around it. Bashir crossed to the nearest one and picked up one of the scanners. He turned it on and watched the screen light up. He did not understand all the words on the screen, but the layout made it possible to guess. 

‘It’ll only work on a hologram,’ Parmak said. ‘But within the simulation, it’s very lifelike.’ 

‘I’m familiar with the concept.’ Bashir put down the scanner and looked at Parmak. ‘How on earth did you get hold of a Cardassian training program?’ 

‘They’re not common,’ Parmak conceded, ‘but you mentioned that you wanted more practice when it came to diagnosing Cardassian patients, and a colleague of mine on Bajor found several programs when she was going through supplies left since the occupation. With no Cardassian government to reclaim them, she thought I might have some use for one of them.’ As if sensing Bashir’s next thought, he added: ‘Elim insisted on looking through the code first. It is exactly what it seems to be.’ 

‘Good,’ Bashir said. ‘I’ve had some odd experiences in the holosuites.’ He pulled himself up and tugged at his uniform. ‘So. Where do we begin? I wouldn’t mind a challenge.’ 

‘Hm.’ Parmak went over to the console, which had been left visible by the program. ‘Let’s start with an asymptomatic patient.’ He entered the commands. ‘There is at least one diagnosable pathology.’ 

‘Sounds good.’ 

Bashir took a deep breath to find some professional composure in the unfamiliar setting. Parmak entered the final commands, and with the smallest of distortions, a person appeared sitting on the table. The woman was young, perhaps mid-twenties, and already dressed in a wrap-around gown. Bashir thought she looked rather lost, staring into the middle distance. He took a step closer. 

‘Hello. I’m Doctor Bashir.’ 

The patient looked at him. Her face was symmetrical, no rashes or lesions or wounds, but it was completely void of emotion.

‘I’d like to examine you,’ Bashir explained. ‘Would that be alright?’

She did not answer, and her face did not change. Perhaps the blankness was actually fear.

‘Can we make you more comfortable somehow?’ he asked. ‘We should be able to arrange a female chaperone, if that would make you feel better.’ 

He glanced up at Parmak, meaning to ask him if the programme allowed for additional characters. Parmak was looking concerned and seemed to be about to say something when Bashir realised his error. The programme was probably written to only allow Cardassian. 

‘ _Ten-da Bashir-qUtro. Ne ten-e peloma-rin?_ ’ 

The woman looked at him as if she had not heard him. 

‘Doctor Bashir…’ Parmak stepped closer. ‘I’m sorry, but what are you doing?’ 

‘I’m introducing myself to the patient,’ Bashir said. ‘Did I get it wrong?’ 

Parmak bit his lip. 

‘No, it was perfectly intelligible, but… there is no reason to talk to her.’ 

Bashir blinked. 

‘I beg your pardon?’ 

‘She is no more than a somewhat more complex anatomy dummy.’ He spoke kindly, as if he was stating an obvious fact that may have gone his colleague by, but Bashir flinched. Saying that in front of a patient, even a holographic one, was wrong. 

‘Computer,’ Bashir said, ‘remove patient.’ 

The woman disappeared. Parmak frowned. 

‘Why did you do that?’ 

‘I can’t have this discussion with her sitting there.’ 

A look of pure confusion settled on Parmak’s face. 

‘I don’t follow,’ he said. ‘She is a hologram, but you acted like she was real.’ 

‘That’s the whole point, isn’t it?’ Bashir said. ‘To pretend it’s real. It’s much better to treat a hologram as a person than a person as a hologram.’ 

‘But you can’t ask her name, or her preference for a chaperone,’ Parmak said. 

‘Why? Those are perfectly valid questions.’

Parmak looked mystified. 

‘The patients are not programmed to speak.’ 

Bashir froze. It took a few seconds until he found his voice again. 

‘Not at all?’ 

‘Well no.’ 

Bashir turned away from Parmak. 

‘Computer,’ he said, ‘reinstate patient.’ 

The woman appeared again. It took effort not to address her again, but Bashir remained quiet as he picked up a penlight and shone it into her eyes. The pupils dilated just as he would expect them to do in a healthy Cardassian. He got a tongue-depressor from the trolley beside the table. 

‘Open your mouth, please.’ 

She opened her mouth. It looked perfectly normal, down to the missing molar, common to all citizens of the old regime. Bashir put the depressor against her tongue.

‘Say aaa.’ 

‘Aaaaa,’ she said, revealing a set of typical Cardassian tonsils. Her voice sounded natural, like he would have thought a Cardassian woman of that age would sound. He discarded the tongue depressor and turned the penlight off. 

‘Thank you,’ he said. ‘Excuse me for a moment.’ 

He crossed to where Parmak had been watching him, his jaw tense and his brow knitted. 

‘Deactivate her again,’ Bashir said under his breath. Parmak entered a command on the console, and they were alone. When he turned back, his face was guarded. 

‘So,’ Bashir said. ‘She understands speech. She obeys requests. She can vocalise. Why not give her the ability to speak?’ 

‘I assume the constructors felt it was superfluous,’ Parmak said. ‘With the amount of effort that goes into this kind of thing, they can be forgiven for not making the patients characters.’ 

‘But don’t you see?’ Bashir said. ‘They need to be characters! You said an asymptomatic patient. But inability to speak feels like a symptom to me. How does it factor into this scenario?’ 

‘It is not a scenario,’ Parmak said, somewhere between perplexed and annoyed. ‘It is just an exercise. You are putting too much faith in this technology…’ 

‘I’ve used Cardassian holotechnology before,’ Bashir said sharply. ‘They can make characters who can talk. If they can simulate pupil dilation, they can do speech.’ 

When Parmak spoke, there was an edge in his voice. 

‘Doctor Bashir, I did not write this programme.’ 

‘But you trained on something like it.’ 

‘Partly, yes.’ 

‘And you don’t seem to think there’s a problem with them. How do you diagnose a patient without communicating with them?’ 

‘That is part of the challenge.’ 

‘But she’s not unconscious or incapacitated or mute. If I touched a tender area, would she react?’ 

‘Yes, I believe so.’ 

‘Would she cry out if it was bad enough?’ 

‘I don’t know about this particular program, but in some of them, yes.’ 

‘Then why not make it an option to ask “are you in any pain”?’ 

Parmak looked crestfallen. 

‘It’s just not the way Cardassian medical training is done.’

Bashir counted to ten. The spark of anger passed, but the simmering outrage was still there. 

‘I’m sorry, I can’t be part of this.’ 

‘There is no “this” to be part of,’ Parmak said, his confusion turning into concern. ‘I don’t know why they made the decision to write the program like this, but surely you are overreacting. It’s just a training program.’ 

Bashir exhaled sharply, not believing his ears. 

‘Don’t you see? It’s not just a training program! You’re teaching your doctors to view patients as things, not as people. You program a holographic patient who can’t speak, can’t object, can’t give informed consent! No wonder there is so little compassion or basic decency in Cardassian medical circles!’

Parmak went very still.

‘I have _never_ mistreated a patient.’ It was quiet, but then his voice grew louder. ‘And you think that because I was trained in this way I have no compassion for people?’ 

‘Look at the kind of doctors this system has trained,’ Bashir shot back. ‘Unsympathetic, cruel, even people like Crell Moset. It’s not an easy thing to accept, but the same system that created you created him.’ 

Parmak had gone very pale. His eyes were wide, his mouth a line. Bashir felt himself deflate. 

‘I’ll show myself out.’ 

He ordered the doors to appear and stepped through. As they closed, he looked back. Parmak was still standing stock-still, frozen in place.

***

It was next morning when Bashir made his way through the habitat ring, the ugly monster that was his bad conscience gnawing at his insides. He stood for a long time waiting for someone to answer the door, and half wishing no one would. When it opened, Garak was on the other side. He looked neither surprised nor pleased to see him.

‘Julian.’ He looked him up and own. ‘This is better timing than I thought you’d have. I’d expected you to come by late last night.’ 

Bashir did not know what to say to that. 

‘Is Doctor Parmak in?’ 

‘He is,’ Garak said, not moving. 

‘I came to talk to him, if he’ll see me.’ 

A voice came from inside the quarters. 

‘You can come in, Doctor Bashir.’ 

Garak stepped aside. 

‘I think I’ll go for a stroll,’ he said, then looked back into the room. ‘Unless you prefer me to stay?’ 

‘Go,’ Parmak said. Garak gave Bashir a brief nod and left. Bashir stepped over the threshold. The door closed behind him. 

Parmak was sitting on the sofa, dressed in what Bashir recognised as Garak’s dressing-gown. Despite the gaudy silk, he looked very pale. His loose hair cascaded down his shoulders, replacing the green and gold with white. As Bashir approached, he saw how Parmak’s eyes flitted away from him. It seemed to take effort to look at him properly. He remained standing. 

‘I came to apologise.’ 

Parmak did not say anything.

‘I acted terribly yesterday, and I’m very sorry.’ He put down the things he had been carrying – a data-rod and a PADD. ‘You left the programme running. I paid Quark for the time it ran over, as I was in there.’ He gestured at the PADD. ‘The patient had a benign growth on her accessory spleen.’ 

It was not quite a smile, but Parmak’s face softened a little. Bashir continued. 

‘My recommendation would be to simply monitor it, as it’s unlikely to become malignant, but if it grows, it could start causing discomfort. If that becomes the case, surgery would be an option.’ 

Parmak’s shoulders relaxed. 

‘Good,’ he said, with no hint of irony. 

‘I wrote up my findings,’ Bashir said. ‘I don’t know what the conventions are in Cardassian medicine, so I just used what I’m used to.’ 

Now, Parmak did smile, even if there was sadness in his eyes. So often, Parmak’s intelligence and wit made it easy to forget how old he was. Now, every year seemed to weigh down on him. 

‘Won’t you sit down?’ he said.

Bashir sat down opposite him. Parmak clasped his hands and gathered his thoughts. It took a long time before he spoke. 

‘Yesterday was difficult. You upset me, but I believe it hit me as hard as it did because I think you are, to some extent, correct.’ 

‘No,’ Bashir said, shaking his head. ‘I was bang out of line. Particularly when I brought up Moset.’ 

Parmak exhaled through his nose in something that verged on a chuckle. 

‘You were closer to the mark than you probably knew with that one,’ he said. ‘Moset studied medicine at the University of the Union at the same time I did. We were not friends by any definition of that word, but we were acquaintances.’ 

Bashir hesitated. 

‘What was he like?’ 

‘Unfortunately, very personable,’ Parmak said. ‘But only to his peers. Anyone below him was little better than a specimen in a jar. When I first met him, he was entirely uninterested until he spotted the signs of my condition. After that, I was no longer another student. I was an example of a rare genetic disorder and that, in his mind, gave him the right to ask me very personal questions within earshot of much of my year.’ 

Bashir shuddered. He remembered the two lectures on genetic augmentation during his training. The dread that his peers would look at him and somehow know his secret had been paralysing. He pushed the memory aside. 

‘I think I got it the wrong way around,’ he said. ‘It’s true that the system that created you also created him, but actually, the system that created Moset also created you. The training is not what made him or people like him what they are. Perhaps better training would have made them less cruel, but you received the same training they did, and you became an excellent doctor. You can’t be blamed for how Cardassian medical training looks.’ 

Parmak shook his head. 

‘No.’ He leaned forward. ‘No, you’re wrong. I can be blamed. Should be.’ 

‘Steady on,’ Bashir said. ‘There’s no need to take this on…’ 

‘You don’t understand,’ Parmak said. There was an intensity in his eyes of a type Bashir had never seen in him before. ‘I had never thought of it this way.’ He stopped to gather his thoughts. ‘Did I tell you how rare these programmes were when I was in training?’ 

‘You mentioned it, yes.’ 

‘Are they used often on Earth?’ 

‘Fairly often,’ Bashir said. ‘Especially early on.’ 

‘And when they weren’t used?’ 

‘It depends. Sometimes we have simulated patients, who are usually actors who learn to simulate different things. We also work with actual patients who are interested in helping with training. It has to be done properly, of course, but expert patients are really invaluable.’ 

Parmak sighed. 

‘Both sound like far better options than what we had.’ 

‘What were those?’ Bashir asked. Even thinking of the possibilities made him feel uncomfortable. 

‘Hospital patients, often sedated. Prisoners. People from the poorest parts of town, who were paid a small amount. Holograms were rare, but I always found them comforting.’ Parmak paused, thinking back. ‘There was one incident that stuck with me. I think it was in my second year. We had a practical, with stations set up in a large room. Each station was one patient, one procedure. There were no screens or partitions – all of it was in plain view. I don’t think it was even commented upon. It was probably just for convenience, to make it easier to move around and for the teachers to see us all. Also, we were often reminded that we could not allow ourselves to be embarrassed. We circled round, so every student did each procedure. There were ninety people in my year. It took all morning. After that, I left the hospital grounds for some reason. I must have had a lecture or a seminar at the main campus. Right outside the hospital gates stood a woman who’d been one of the patients.’ Parmak paused, lost in the memory. ‘She was weeping so hard her inhales were just odd little gulps of air. I… wanted to help, somehow, so I approached. I think she recognised me from the practical. As soon as she caught sight of me, she turned and ran.’ 

Bashir did not quite know what to say. 

‘Do you think something happened to her?’ 

‘You mean something untoward?’ 

‘Yes.’ 

‘I couldn’t rule it out, but spending hours being stared at and manhandled by almost a hundred people… that is in itself untoward. She was probably not told what was going to happen. She had no way of stopping it. And all she got for it was twenty _lek_ or so. Not enough for a single meal for a family.’ Parmak sighed deeply. ‘I couldn’t stop thinking about that woman. I tried to tell my friends about her, to make them understand, but none of them saw what was so upsetting about it. They simply shrugged. Patients cry – because they’re in pain, because they’re scared. It’s not our business. We’re there to do a job. So you see, when I was given the opportunity to train on holograms, it was a relief. I knew they would not cry afterwards. They could not feel violated. They had no life outside that one situation. To me, it was a way of saving one of those people who were so destitute they were forced to accept money to be objectified and not given even the most common form of decency while it happened.’ He looked down at his hands. ‘But perhaps all it did was make me complacent. It might breed something worse further down the line.’ 

He fell silent. Bashir felt his shame of the harsh things he said mix with guilt at causing this distress. It was with an effort that Parmak spoke. 

‘But it’s all gone now.’ His voice trembled.

Bashir bit his lip. 

‘Cardassia will be rebuilt,’ he said. ‘And things are going to change. You – as a society – have the possibility to start over.’ 

‘There are still reactionary elements. Many of them. Real change is not guaranteed.’ 

‘It won’t happen on its own. It needs to be made to happen.’ 

‘And yet here I am,’ Parmak said. ‘In the safety of a Federation station. I should have stayed and helped.’ 

‘You can go back,’ Bashir said. ‘And it wasn’t like you left for some selfish reason. Your life was in danger.’ Cardassia may be a very different place since the Dominion war, but its opinions on inverts had not changed. 

Parmak did not look convinced by this argument. 

‘I do not know if that is an excuse.’ 

‘It’s not an excuse. It’s a reason – a legitimate one.’ The idea that had been at the back of his mind now seemed like a real possibility. ‘And it’s not like you can’t help from here. It seems to me that we both agree that, whatever happens on Cardassia, the way they train their doctors has to change. Even if there’s not democracy, when the rebuilding gets underway it won’t go back to the way it was. Now is when change has to happen.’ 

The look of scepticism was not entirely gone from Parmak’s face, but he was listening more intently now. 

‘What did you have in mind?’ he asked. 

‘For one thing, you could outline a syllabus on medical ethics and guidelines for patient involvement in teaching.’ 

Parmak smiled a little. 

‘That would be useful.’ 

‘There’s another thing,’ Bashir said. ‘And it might be mad, but I think it could be a good idea.’ 

‘I’m listening.’ 

‘I have a friend – Felix. He designs holosuite programs. He mostly does fiction stuff, but he’s been involved with all sorts of projects. I could get in touch with him about designing a medical training program with Cardassian patients, with proper patient-doctor interactions. With the relief effort going on now, Starfleet Medical might be interested enough to give us access to their resources, and they’d be more than happy to share it with any Cardassian teaching institutions. I’ve never done anything like that, but, between us, I think we could write some good stuff.’

Parmak looked at him for a moment. 

‘Are you suggesting I go into business with you?’ 

‘I guess so,’ Bashir said. ‘I mean, there’s no money in it. But it could make a real difference.’ 

Parmak thought for a moment. Then he smiled.

‘It doesn’t sound like a mad idea at all.’ 

He put his hand out. Bashir took it and grinned.


End file.
